Restraints orders are to be filled out every morning on rounds for every patient requiring restraints. The state of Missouri levies heavy fines for any unit shown to be non-compliant with medical restraint guidelines. In order to maintain compliance with the state’s laws on restraints, Barnes-Jewish Hospital has a specific restraint policy that adheres to JCAHO standards. If a patient requires restraints, physician orders must be written within one hour of placing the restraints. The reason for placing restraints must be entered in the physician order entry system. If a patient requires restraints, this MUST be documented in the Epic section marked NV Restraint Face to Face and in a progress note specifying the reason for restraint usage. A statement such as “patient safety” does NOT suffice (prevention of specific device removal, does, though).
An example of an appropriate statement (for a patient on the ventilator) is “prevention of extubation which could result in hypoxia and/or respiratory insufficiency.” Another example (for a patient on pressors) is “to prevent patient from pulling out central line, which could result in hypotension since the central line is giving vasoactive medications needed to support blood pressure.” For upper extremity soft wrist restraints (ICU patient with invasive devices), an order must be written once when initiated; this order is sufficient for the duration of time the restraints remain on the patient. Any other type of restraints such as bed, chair, 4-point, etc., require daily written orders. If the restraints are discontinued at any time (e.g., improvement in mental status), the “ICU patient with invasive devices” order must be re-entered, but again will not require a daily order. If this is confusing seek out your fellow, attending, or clinical nurse specialist for clarification.